Diferencias de género en el tratamiento de revascularización precoz del infarto agudo de miocardio

The Effect of Monthly Medication on Mortality After a Coronary Event

AIM

The aim of this study was to analyze how the consumption of medication over time affects the survival rate in patients with a coronary event and whether there is a gender difference.

METHODS

The study included 804 patients admitted to 4 hospitals with a coronary event during 2007. Monitoring after coronary event was carried out during 2007 and every 6 months in the subsequent 2 years (2008 and 2009) throughout the review of the clinical history of the patient. The main outcome was the analysis of mortality after the coronary event. Kaplan-Meier survival curves were plotted to calculate the time to death, comparing women versus men for 4 medication groups: aspirin, statins, β-blockers, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs). A Cox regression model was used for the final mortality analysis.

RESULTS

During the follow-up time, 172 deaths were assessed. Each month of treatment with aspirin, statins, β-blockers, or ACEI/ARB was associated with a decrease in mortality between 13.0% and 0.5% (univariate analysis). The Kaplan-Meier method revealed a significant reduction in mortality after the coronary event for each month of treatment with aspirin (men), statins (men), and β-blockers (both men and women). No significant effect in survival was observed in either gender with ACEI/ARB treatment. The final multivariable model (Cox regression) showed that the taking of aspirin, statins, β-blockers, or ACEI/ARB is able to reduce mortality rates up to 7.0% (aspirin) throughout each month of treatment after a coronary event without any influence of gender.

CONCLUSION

Aspirin, statins, β-blockers, and ACEI/ARB revealed a protective character with each month of treatment throughout the follow-up period, in terms of risk reduction of death. Aspirin and statins showed the maximum benefit, followed by ACEI/ARB and β-blockers.

[Gender differences in the use of tumour markers]

INTRODUCTION AND OBJECTIVE

Gender is one of the factors that can influence the use of health resources. The use of tumour markers is widespread, due to the importance of these in monitoring cancer development. The aim of this study is to analyse the influence of gender on the use of tumour markers, and to investigate whether there are differences in their use.

MATERIAL AND METHODS

A longitudinal, retrospective and descriptive study, with a 2-year follow-up, was conducted in the catchment area of the University Hospital of Padua. An analysis was performed on 23,059 analytical requests for tumour markers. A descriptive and frequency analysis was performed on all variables. The statistical analysis was performed using Chi squared, Student t and Mann-Whitney U to test for significance.

RESULTS

The number of requests for women (1.5) was lower than men (1.6). In patients with tumour pathology, the number of requests was higher than in patients without tumour disease. In the analysis by disease and gender, the difference remained significant. As regards the number of tumour markers per request, the difference between genders was also significant: 2.13 in males versus 2.85 in women. Similar results were obtained when requests for tumour markers linked to gender-related diseases were eliminated.

CONCLUSIONS

There are differences in the use of tumour markers by gender with the number of requests for male patients being higher than for females. However, the number of tumour markers per request is greater in women than in men.

[Acute coronary syndrome in women. Gender differences]

BACKGROUND AND OBJECTIVE

Our aims was to investigate possible gender differences in the diagnostic assessment, treatment and prognosis of patients admitted with acute coronary syndrome (ACS).

PATIENTS AND METHODS

Prospective study of a cohort of 396 patients consecutively admitted to the coronary unit in the period of 18 months with the diagnoses of ACS. We divided the sample into two groups based on gender: 294 men and 102 women. We analysed the diagnostic assessment, hospital treatment, coronary revascularization (ICP), appearance of heart failure (HF) and in-hospital and 1-year mortality. We analyzed predictors of mortality in a multivariate model.

RESULTS

Women were older (70.9±11.9 versus 64.4±12.0; P<.001) and had more comorbidities such as hypertension (70.5% versus 53.7%; P=.003), diabetes (51.0% versus 33.3%; P<.01) and HF (20.5% versus 9.1%; P<.01) than men, while men had greater frequency of smoking (54.42% versus 13.73%; P<.001). Women had higher incidence of cardiogenic shock on admission. There were no differences in thrombolysis and women did not have a different pattern of access to coronary angiography, but men had greater frequency of ICP (50.8% versus 34.6%; P<.01). Women were more likely to develop a higher in-hospital HF (32.6% versus 25.9%; P<.05) and in-hospital mortality (17.6% versus 4.7%; P<.001). In the multivariate analyses, HF on admission OR 8.98 (3.29-24.47), older age OR 1.07 (1.01-1.13) and female gender OR 3.14 (1.27-7.74), were independent predictors of in-hospital mortality.

CONCLUSIONS

In our study, female gender was an independent predictor of in-hospital mortality in patients with ACS.

Sex differences in relative survival and prognostic factors in patients with a first acute myocardial infarction in Guipuzcoa, Spain

INTRODUCTION AND OBJECTIVES

To determine 28-day and 5-year survival rates in patients who have experienced a first acute myocardial infarction and to identify prognostic factors for survival.

METHODS

This study involved 1,677 patients with a first acute myocardial infarction who were treated at a hospital in Guipuzcoa, Spain between 1997 and 2000.

RESULTS

Women were approximately 10 years older than men, presented more often with diabetes and hypertension, were in a less favorable clinical condition, and consumed fewer medical resources, but were less likely to smoke. Survival rates at 28 days and 5 years were higher in men over 60 years of age. In the period from 29 days to 5 years, the relative survival rate was higher in men from all age groups. Factors associated with short- and long-term survival varied between the sexes. Disease severity in the acute phase and, later on, age were associated with survival in both men and women, whereas the effect of other variables differed between the sexes.

CONCLUSIONS

Myocardial infarction is a condition associated with high mortality in the acute phase. There is an interaction between sex and age that affects survival after an acute myocardial infarction. A number of factors are associated with poor short- and long-term prognoses in both sexes.